Skip to main content
Log in

Current studies on myofascial pain syndrome

  • Published:
Current Pain and Headache Reports Aims and scope Submit manuscript

Abstract

Recent studies have clarified the nature of myofascial trigger points (MTrPs). In an MTrP region, multiple hyperirritable loci can be found. The sensory components of the MTrP locus are sensitized nociceptors that are responsible for pain, referred pain, and local twitch responses. The motor components are dysfunctional endplates that are responsible for taut band formation as a result of excessive acetylcholine (ACh) leakage. The concentrations of pain- and inflammation-related substances are increased in the MTrP region. It has been hypothesized that excessive ACh release, sarcomere shortening, and release of sensitizing substances are three essential features that relate to one another in a positive feedback cycle. This MTrP circuit is the connection among spinal sensory (dorsal horn) neurons responsible for the MTrP phenomena. Recent studies suggest that measurement of biochemicals associated with pain and inflammation in the MTrP region, the sonographic study of MTrPs, and the magnetic resonance elastography for taut band image are potential tools for the diagnosis of MTrPs. Many methods have been used to treat myofascial pain, including laser therapy, shockwave therapy, and botulinum toxin type A injection.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

  1. Hong CZ, Simons DG: Pathophysiologic and electrophysiologic mechanism of myofascial trigger points. Arch Phys Med Rehabil 1998, 79:863–872.

    Article  PubMed  CAS  Google Scholar 

  2. Simons DG: Clinical and etiological update of myofascial pain from trigger points. J Musculoskelet Pain 1996, 4:93–121.

    Article  Google Scholar 

  3. Simons DG, Travell JG, Simons LS: Travell & Simons’s Myofascial Pain and Dysfunction: The Trigger Point Manual, vol 1, edn 2. Baltimore: Williams & Wilkins; 1999.

    Google Scholar 

  4. Mense S, Simons DG: Muscle Pain: Understanding Its Nature, Diagnosis, and Treatment. Philadelphia: Lippincott Williams & Wilkins; 2001.

    Google Scholar 

  5. Hong CZ: Algometry in evaluation of trigger points and referred pain. J Musculoskelet Pain 1998, 6:47–59.

    Article  Google Scholar 

  6. Hong CZ, Chen JT, Chen SM, et al.: Histological findings of responsive loci in a myofascial trigger spot of rabbit skeletal muscle from where localized twitch responses could be elicited (abstract). Arch Phys Med Rehabil 1996, 77:962.

    Google Scholar 

  7. Simons DG: Do endplate noise and spikes arise from normal motor endplates? Am J Phys Med Rehabil 2001, 80:134–140.

    Article  PubMed  CAS  Google Scholar 

  8. Simons DG, Hong CZ, Simons LS: Prevalence of spontaneous electrical activity at trigger spots and at control sites in rabbit skeletal muscle. J Musculoskelet Pain 1995, 3:35–48.

    Article  Google Scholar 

  9. Simons DG, Hong CZ, Simons LS: Endplate potentials are common to midfiber myofascial trigger points. Am J Phys Med Rehabil 2002, 81:212–222.

    Article  PubMed  Google Scholar 

  10. Kuan TS, Hong CZ, Chen JT: The spinal cord connections of myofascial trigger spots. Euro J Pain 2007, 11:624–634.

    Article  Google Scholar 

  11. Kuan TS, Chen JT, Chen SM, et al.: Effect of botulinum toxin on endplate noise in myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2002, 81:512–520.

    Article  PubMed  Google Scholar 

  12. Simons DG: New aspects of myofascial trigger points: etiological and clinical. J Musculoskelet Pain 2004, 12:15–21.

    Article  Google Scholar 

  13. Hong CZ, Yu J: Spontaneous electrical activity of rabbit trigger spot after transection of spinal cord and peripheral nerve. J Musculoskelet Pain 1998, 6:45–58.

    Article  Google Scholar 

  14. Kuan TS, Lin TS, Chen JT, et al.: No increased neuromuscular jitter at rabbit skeletal muscle trigger spot spontaneous electrical activity sites. J Musculoskelet Pain 2000, 8:69–82.

    Article  Google Scholar 

  15. Chang CW, Chen YR, Chang KF: Evidence of neuroaxonal degeneration in myofascial pain syndrome: a study of neuromuscular jitter by axonal microstimulation. Eur J Pain 2008, 12:1026–1030.

    Article  PubMed  Google Scholar 

  16. Shah JP, Danoff JV, Desai MJ, et al.: Biochemicals associated with pain and inflammation are elevated in sites near to and remote from active myofascial trigger points. Arch Phys Med Rehabil 2008, 89:16–23.

    Article  PubMed  Google Scholar 

  17. Shah JP: Uncovering the biochemical milieu of myofascial trigger points. Using in vivo microdialysis. J Musculoskelet Pain 2008, 16:17–20.

    Article  Google Scholar 

  18. Simons DG: New views of myofascial trigger points: etiology and diagnosis (commentary). Arch Phys Med Rehabil 2008, 89:157–159.

    Article  PubMed  Google Scholar 

  19. Kuan TS, Hsieh YL, Chen SM, et al.: The myofascial trigger point region: correlation between the degree of irritability and the prevalence of endplate noise. Am J Phys Med Rehabil 2007, 86:183–189.

    Article  PubMed  Google Scholar 

  20. Chou LW, Hsieh YL, Kao MJ, et al.: Remote influences of acupuncture on the pain intensity and the amplitude changes of endplate noise in the myofascial trigger point of the upper trapezius muscle. Arch Phys Med Rehabil 2009, 90:905–912.

    Article  PubMed  Google Scholar 

  21. Chen KH, Hong CZ, Kuo FC, et al.: Electrophysiologic effects of a therapeutic laser on myofascial trigger spots of rabbit skeletal muscles. Am J Phys Med Rehabil 2008, 87:1006–1014.

    Article  PubMed  Google Scholar 

  22. Chen JT, Chung KC, Hou CR, et al.: Inhibitory effect of dry needling on the spontaneous electrical activity recorded from myofascial trigger spots of rabbit skeletal muscle. Am J Phys Med Rehabil 2001, 80:729–735.

    Article  PubMed  CAS  Google Scholar 

  23. Chen JT, Chen SM, Kuan TS, et al.: Phentolamine effect on the spontaneous electrical activity of active loci in a myofascial trigger spot of rabbit skeletal muscle. Arch Phys Med Rehabil 1998, 79:790–794.

    Article  PubMed  CAS  Google Scholar 

  24. Kostopoulos D, Nelson AJ, Ingber RS, et al.: Reduction of spontaneous electrical activity and pain perception of trigger points in the upper trapezius muscle through trigger point compression and passive stretching. J Musculoskelet Pain 2008, 16:266–278.

    Article  Google Scholar 

  25. Hong CZ, Chen YN, Twehous D, et al.: Pressure threshold for referred pain by compression on the trigger point and adjacent areas. J Musculoskelet Pain 1996, 4:61–79.

    Article  Google Scholar 

  26. Fricton JR, Auvinen MD, Dykstra D, et al.: Myofascial pain syndrome: electromyographic changes associated with local twitch response. Arch Phys Med Rehabil 1985, 66:314–317.

    PubMed  CAS  Google Scholar 

  27. Simons DG, Dexter JR: Comparison of local twitch responses elicited by palpation and needling of myofascial trigger points. J Musculoskelet Pain 1995, 3:49–61.

    Article  Google Scholar 

  28. Hong CZ, Torigoe Y: Electrophysiologic characteristics of localized twitch responses in responsive bands of rabbit skeletal muscle fibers. J Musculoskelet Pain 1994, 2:17–43.

    Article  Google Scholar 

  29. Hong CZ, Torigoe Y, Yu J: The localized twitch responses in responsive bands of rabbit skeletal muscle fibers are related to the reflexes at spinal cord level. J Musculoskelet Pain 1995, 3:15–33.

    Article  Google Scholar 

  30. Hong CZ: Myofascial pain therapy. J Musculoskelet Pain 2004, 12:37–43.

    Article  Google Scholar 

  31. Hong CZ: Treatment of myofascial pain syndrome. Curr Pain Headache Rep 2006, 10:345–349.

    Article  PubMed  Google Scholar 

  32. Kao MJ, Han TI, Kuan TS, et al.: Myofascial trigger points in early life. Arch Phys Med Rehabil 2007, 88:251–254.

    Article  PubMed  Google Scholar 

  33. Myburgh C, Larsen AH, Hartvigsen J: A systemic, critical review of manual palpation for identifying myofascial trigger points: evidence and clinical significance. Arch Phys Med Rehabil 2008, 89:1169–1176.

    Article  PubMed  Google Scholar 

  34. Gerwin RD, Shannon S, Hong CZ, et al.: Identification of myofascial trigger points: interrater agreement and effect of training. Pain 1997, 69:65–73.

    Article  PubMed  CAS  Google Scholar 

  35. Gerwin RD, Duranleau D: Ultrasound identification of the myofascial trigger point [letter]. Muscle Nerve 1997, 20:767–768.

    PubMed  CAS  Google Scholar 

  36. Chen Q, Bensamoun S, Basford JR, et al.: Identification and quantification of myofascial taut bands with magnetic resonance elastography. Arch Phys Med Rehabil 2007, 88:1658–1661.

    Article  PubMed  Google Scholar 

  37. Chen SM, Chen JT, Kuan TS, et al.: Decrease in pressure pain thresholds of latent myofascial trigger points in the middle finger extensors immediately after continuous piano practice. J Musculoskelet Pain 2000, 8:83–92.

    Article  Google Scholar 

  38. Kawakita K, Itoh K, Okada K: Experimental model of trigger points using eccentric exercise. J Musculoskelet Pain 2008, 16:29–35.

    Article  Google Scholar 

  39. Gerwin R: Differential diagnosis of trigger points. J Musculoskelet Pain 2004, 12:23–28.

    Article  Google Scholar 

  40. Gerwin RD: The management of myofascial pain syndromes. J Musculoskelet Pain 1993, 1:83–94.

    Article  Google Scholar 

  41. Srbely JZ, Dickey JP: Randomized controlled study of the antinociceptive effect of ultrasound on trigger point sensitivity: novel applications in myofascial therapy? Clin Rehabil 2007, 21:411–417.

    Article  PubMed  Google Scholar 

  42. Hong CZ: Lidocaine injection versus dry needling to myofascial trigger point: the importance of the local twitch response. Am J Phys Med Rehabil 1994, 73:256–263.

    Article  PubMed  CAS  Google Scholar 

  43. Snyder-Mackler L, Bork C, Bourbon B, et al.: Effect of helium-neon laser on musculoskeletal trigger points. Phys Ther 1986, 66:1087–1090.

    PubMed  CAS  Google Scholar 

  44. Bauermeister W: The diagnosis and treatment of myofascial trigger points using shockwaves. J Musculoske Pain 2004, 12(Suppl 9):13.

    Google Scholar 

  45. Cheshire WP, Abashian SW, Mann JD: Botulinum toxin in the treatment of myofascial pain syndrome. Pain 1994, 59:65–69.

    Article  PubMed  CAS  Google Scholar 

  46. Wheeler AH, Goolkasian P, Gretz SS: A randomized, double-blind, prospective pilot study of botulinum toxin injection for refractory, unilateral, cervicothoracic, paraspinal, myofascial pain syndrome. Spine 1998, 23:1662–1667.

    Article  PubMed  CAS  Google Scholar 

  47. Kamanli A, Kaya A, Ardicoglu O, et al.: Comparison of lidocaine injection, botulinum toxin injection, and dry needling to trigger points in myofascial pain syndrome. Rheumatol Int 2005, 25:604–611.

    Article  PubMed  CAS  Google Scholar 

  48. Lew HL, Lee EH, Castaneda A, et al.: Therapeutic use of botulinum toxin type A in treating neck and upper-back pain of myofascial origin: a pilot study. Arch Phys Med Rehabil 2008, 89:75–80.

    Article  PubMed  Google Scholar 

  49. Graboski CL, Gray DS, Burnham RS: Botulinum toxin A versus bupivacaine trigger point injections for the treatment of myofascial pain syndrome: a randomized double blind crossover study. Pain 2005, 118:170–175.

    Article  PubMed  CAS  Google Scholar 

  50. Melzack R: Myofascial trigger points: relation to acupuncture and mechanism of pain. Arch Phys Med Rehabil 1981, 62:114–117.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Ta-Shen Kuan.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kuan, TS. Current studies on myofascial pain syndrome. Current Science Inc 13, 365–369 (2009). https://doi.org/10.1007/s11916-009-0059-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11916-009-0059-0

Keywords

Navigation